Transition From Targeted Decolonization to Universal Decontamination: Effect on Postoperative S. aureus Infection Rate in a Single Institution
Background:
•Colonization with S. aureus is a risk factor for surgical site infection (SSI) following total joint arthroplasty1
•Universal decontamination (UD) protocols are non-inferior to targeted decolonization (TD) in reducing S. aureus SSI2-4
•UD protocols are cost-effective and practical for implementation
•Studies are needed to investigate institutional transitions from TD to UD to understand its effects on postoperative SSI and S. aureus SSI in clinical practice
Objective:
Evaluate the transition from a TD protocol to a UD protocol at an orthopaedic specialty hospital by analyzing S. aureus SSI incidence over time
Methods:
Retrospective cohort study
Inclusion criteria:
•Primary or revision TKA or THA between 6/3/2024 and 12/31/2025
Exclusion Criteria:
•Any documented SSI prior to the analysis period
•A month transition period immediately following implementation was excluded from analysis
Exposure periods:
•Targeted: Preop mupirocin for 5 days for colonized patients
•Universal 5%: Intranasal 5% povidone-iodine solution prior to surgery, beginning January 27th, 2025
•Universal 10%: Intranasal 10% povidone-iodine solution prior to surgery, beginning October 1st, 2025
Primary outcome:
•Postoperative S. aureus surgical site infection, defined by NHSN criteria
Analysis
•Cumulative Sum (CUSUM) analysis with a target performance set to the pre-transition infection rate of 0.32%
•Multivariate logistic regression
Patient Demographics/Results:
•7768 who underwent primary or revision TKA or THA were included
•There were 3427 procedures in the TD period and 4341 in the UD period
•A total of 16 cases of postoperative S. aureus SSI were documented during the study period, 2 before the transition period and 14 after (p=0.022)
•CUSUM analysis demonstrated an initial incline in infection rate, exceeding the acceptable performance target by March 2025
•Infection risk remained elevated during the 5% period
•Following the 10% transition, infection rate corrected
•Multivariate logistic regression analysis show that a UD protocol conferred a significantly higher odds of infection (OR 5.38, 95% CI: 1.48 – 34.5)
Conclusion:
A universal decontamination protocol with 10% intranasal iodine demonstrated comparable S. aureus SSI outcomes to targeted, and both targeted and universal were superior to 5% intranasal iodine
